Document Detail

Compared to conventional ventilation, airway pressure release ventilation may increase ventilator days in trauma patients.
MedLine Citation:
PMID:  23019679     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Airway pressure release ventilation (APRV) is used both as a rescue therapy for patients with acute lung injury and as a primary mode of ventilation. Unlike assist-control volume (ACV) ventilation that uses spontaneous breathing trials, APRV weaning consists of gradual decreases in supporting pressure. We hypothesized that the APRV weaning process increases total ventilator days compared with those of spontaneous breathing trials-based weaning.
METHODS: A retrospective review of a Level I trauma center's database identified trauma admissions from January 1, 2007, to December 31, 2010, which required mechanical ventilation for more than 24 hours and survived. Demographics, injuries, in-hospital complications, ventilation mode(s), and total ventilator days were abstracted.
RESULTS: A total of 362 patients fulfilled study entry criteria; 53 patients with more than one ventilator mode change were excluded. Seventy-five patients were successfully liberated from mechanical ventilation on APRV and 234 on ACV. The APRV and ACV groups, respectively, were similar in age (46.1 vs. 44.6 years) and sex (72% vs. 73% male) but differed in Injury Severity Score (20.8 vs. 17.5; p = 0.03). Patients on APRV had higher rates of abdominal compartment syndrome (6.7% vs. 0.8%, p = 0.003) and were more likely to have a higher chest Abbreviated Injury Scale (AIS) score ≥3 (57.3% vs. 30.8%, p < 0.001). Ventilator days were significantly greater in the APRV group (19.6 vs. 10.7 days, p < 0.001). Multiple regression was performed to adjust for the clinical differences between the two groups, identifying APRV as an independent predictor for increased number of ventilator days (B = 6.2 ± 1.5, p < 0.001) in addition to male sex, abdomen AIS score of 3 or higher, spine AIS score of 3 or higher, acute renal failure, and sepsis.
CONCLUSION: APRV is frequently used for patients who are more severely injured or who develop in-hospital complications such as pneumonia. However, after controlling for potential confounding factors in a multiple regression model, the APRV mode itself seems to increase ventilator days.
Adrian A Maung; Kevin M Schuster; Lewis J Kaplan; Michael F Ditillo; Greta L Piper; Linda L Maerz; Felix Y Lui; Dirk C Johnson; Kimberly A Davis
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  73     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-09-27     Completed Date:  2012-10-18     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  507-10     Citation Subset:  AIM; IM    
Section of Trauma, Surgical Critical Care and Surgical Emergencies, Department of Surgery, School of Medicine, Yale University, New Haven, CT 06520, USA.
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MeSH Terms
Continuous Positive Airway Pressure / adverse effects,  methods*
Databases, Factual
Follow-Up Studies
Injury Severity Score
Intensive Care / methods
Intra-Abdominal Hypertension / diagnosis,  epidemiology
Length of Stay
Linear Models
Middle Aged
Multivariate Analysis
Pulmonary Gas Exchange
Respiration, Artificial / methods*
Retrospective Studies
Risk Assessment
Survival Rate
Time Factors
Trauma Centers
Treatment Outcome
Ventilator Weaning*
Wounds and Injuries / diagnosis,  mortality,  therapy*
Comment In:
J Trauma Acute Care Surg. 2013 May;74(5):1378   [PMID:  23609297 ]
J Trauma Acute Care Surg. 2013 May;74(5):1377-8   [PMID:  23609296 ]

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